Conducting Investigations in a Long-Term Care Facility: Understanding the Obligations
Jeannine LeCompte, Compliance Research Specialist
It is well-known that all long-term care facilities served by Medicare and Medicaid are under a legal obligation to provide the maximum possible care for their residents—but it is less well-known that there is an equally stringent obligation upon such facilities to provide a full and proper investigation for any incidents which may occur. In addition, there is also a legal obligation upon facilities to prepare written policies and procedures for investigating any incidents of abuse, neglect, resident exploitation, or misappropriation of a resident’s funds or property.
The obligation to develop these policies falls under F607 (Develop/Implement Policies and Procedures for Abuse/Neglect/Exploitation/Misappropriation), and the failure to conduct a proper investigation will almost certainly lead to deficiency citations.
In particular, F607 states that these written policies and procedures must be crafted in a manner which prohibits and prevents any of the abuses outlined above, and guidelines established for the investigation of any incidents. This guideline must also require any additional training which may be necessary: for staff directly involved in the investigation, and those on the periphery, who need to be aware of their duties in and around a crime scene, for example.
Previous experience has shown that the Department of Health has cited deficiencies when there were failures in the investigation process. Deficiencies can include instances of available documentation which does not support an investigation’s conclusion; or when the investigation itself was not conducted properly, or if it contains contradictory or too little information.
An investigation may also be looked upon by regulators as worthless services resulting in charges of fraud, waste, and abuse of government funds if it was not reported to the Department of Health and/or conducted in a thorough and timely manner for any allegation of abuse, neglect, exploitation, and/or mistreatment of a resident; or, in the case of a crime or a suspected crime, the local police were not notified.
It is therefore clear that the proper conduction of an investigation has an important impact on a facility’s standing in the eyes of regulators and the law as a component of the effort to prevent any type of abuse.
